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Liberal Democrats Party conference
Fringe meeting discusses cuts
24th of September 2009
The party conferences are upon us. The DDA will be represented at all three national conferences. We are arranging to meet with many MPs from all parties.
Dr David Baker and Mr Jeff Lee have been attending the Liberal Democrat conference. At a fringe meeting on "Cash for health: paying the price for quality" It was suggested that the three main components of quality in healthcare were the effectiveness of the outcome, safety and patient experience. Shadow Health Minister Sandra Gidley (who is also a pharmacist) made the case that patient safety was the most important element of quality healthcare.
Kevin Cleary from the National Patient Safety Agency also argued that safety was the key issue in providing quality healthcare. He said that healthcare systems were built upon many platforms and that at the moment ours was built around effectiveness and outcome. He said that we needed to look again at how we delivered healthcare and that the basic platform needed redesigning. He argued that in the aviation or nuclear industries our first question was not whether the plane or nuclear power station was efficient, but whether it was safe. Mr Cleary also argued that increased safety would lead to decreased costs. Hospital acquired infections and litigation costs were very expensive he said. He concluded that safety was core to efficiency, good outcomes and patient satisfaction.
Speaking from the floor, the Chief Executive of the Dispensing Doctors' Association commented that a good outcome had to include safety and an excellent patient experience. He said that these issues could not be separated.
Another fringe meeting discussed, Will necessity be the mother of invention in the NHS? Challenges for the next Government
This meeting addressed the funding problems health is about to experience. It makes sobering reading. Although it is a long report, it is worth reading because it lets you know what the politicians and the think tanks have planned for us next.
Speaking were the following:
Norman Lamb MP, Shadow Health
Steve Barnett - NHS Confederation
Dan Wellings - Ipsos Mori
David Furness - Social Market Foundation (SMF)
Mr Wellings referred to the NHS Confederation report and highlighted the NHS is facing severe contraction in its budget, which requires strong leadership - a factor that is more vital than ever before. Diluting quality and structural change should be avoided - the NHS will not survive the impending spending squeeze without change however. 75 percent of the public do not think the NHS need cuts, they instead believe simple changes need to be made. Commenting on evidence, he said that 82 percent of the public think the NHS should be ring-fenced in terms of cuts, which he stated represents the incredible emotional relationship the public has with the NHS.
Mr Furness commenced by turning to the NHS Confederation publication which described the downturn as ‘unprecedently difficult' - something Mr Furness said was an incredibly polite description. He spoke of the need to be realistic and honest with NHS cuts, pointing to funding which has trebled over the last decade that will suddenly face cut-backs.
On cultural change in the NHS, Mr Furness said people have been very used to working in a certain way, with lots of money available. The NHS has changed beyond all recognition for the better, he said - due to recent funding and highlighted the massive pressures in the current climate on every pound spent. He argued the NHS is quite risk averse, due to the political accountability - when budgets go wrong people are worried for their jobs and reputation, which he said encourages people to play safe. In terms of developing new ways of management, being risk averse is no good, he added.
Mr Furness said purchases will be key to change in the NHS and said if people are to be encouraged to take risks, purchases should put pressure on hospitals to change. He told of inbalance of power, with prestige organisations running rings around smaller primary care trusts. He recommended improving the role of commissioners within the NHS. There is a real onus on politicians to be open and transparent in dialogue with changes that are required, he added.
Turning to the political challenge of implementing change, he said hospital closures will soon return to the debate. He spoke of the need to close a number of hospitals down and highlighted the public reaction to such developments, with it being such an emotional issue. He questioned how best to engage people in such tough decisions which he said need to be made. Without such closures, the NHS will move towards a second rate system, depriving other valuable areas such as mental health.
Mr Furness spoke of research which suggested people are wedded to the idea of a unified NHS. People will accept changes better than is assumed, he added and said there is already variation in the NHS and there will be increased levels locally. Mr Furness stressed the importance of keeping people informed in the debate and open throughout. The NHS needs more and better management, not less of it; he said and called for dialogue on exactly what the NHS does, with a rethink in terms of wider national conversation. He said the NHS Constitution represented a real missed opportunity to properly engage people in discussion.
Mr Wellings spoke of NHS Confederation work that showed that people accept variation if they accept geographical needs, however they do not accept different levels of standards.
There is a window before the funding gets seriously squeezed to be more innovative, Mr Furness said, speaking of a shift from top-down governance from Whitehall and more local decision making.
Mr Barnett referred to statistics in the NHS Confederation publication, expressing shock at the potential cuts faced. He described it as a possible crisis in funding for the NHS, taking into account different issues including technological advances. He emphasised the scale of the challenge, stating the situation could last for the next six years.
Mr Barnett said the politicians are not discussing the issues in an open and public way and said in the context of the upcoming election it is difficult for any politician to come forward with messages about the required potential changes. Discussion on management structures and the abolition of Qangos misses the point of the challenge faced he said, which is £3.6 billion per year, each year. Cutting the price of the tariff simply passes on the pressure for cost saving onto different hospitals, he said.
Top-down, structural reorganisation usually produces negative results and causes more problems than it solves, he said. Mr Barnett took the idea of moving commissioning responsibility to local Government, stating there is no evidence to suggest people are better at acting locally.
On pay, 60-70 percent of cost of the NHS goes into pay and pensions, Mr Barnett said, placing pay at the heart of the financing debate. The NHS Confederation thinks attention to clinical and non-clinical part of organisations is needed, to strip out waste. There should also be a rethink of the way patients move through the system to make sure they receive care in the most appropriate settings. Thirdly, the first two stages should allow for changing delivery systems, allowing for hospital closures and reducing numbers - which he said is incredibly difficult for politicians to contemplate pre-election, even though he said these are vital to making savings. Fourthly, he highlighted difficult decisions about which services will receive investment and spoke of the tough debates of having to discontinue some areas. Since 2000 the NHS has been used to receiving significant additional investment and in some sense has therefore lost the knowledge of living without excess. The payment-by-result system incentivises big hospitals to get patients ‘through the door,' which he said generates money, adding the Government's policy is to move care into primary care settings, which he said cannot work with the current set off incentives.
Finally he said the changes will take time, and there will be early difficult choices. He expressed the need for mature discussions to take place with trade unions to see what can be done with NHS paybill and NHS pension scheme. This is the biggest leadership decision the NHS has ever had to take, which will involve engaging people across the entire sector.
Arriving late, Norman Lamb MP said necessity has to be the mother of invention, stating there is choice. He spoke of the climate in 2005/06 - the last time there was a squeeze in the NHS- which resulted in crisis management, with mental health losing out. Mr Lamb said mental health loses out for payment by result reasons, as well as 18 week targets for treatment, sucking money into acute hospitals, while mental health trusts negotiate block payments with acute trusts, often diluting the funding. In 2005/06 real cuts were taking place, he said and expressed the need to avoid the same culture of ‘slash and burn.'
Mr Lamb said having spoken to health economists, there could be a 10 percent saving generated through efficiency. Mr Lamb said when money keeps flowing in at a very fast rate, it is too easy to spend the money and therefore not ensure it is spent in the utmost efficient way.
Turning to the NHS Confederation report: "What's it all for" he said it made the point there are over 60 national organisations inspecting every hospital across the land, frequently asking the same questions, while applying different standards.
On prevention, he said that money does not flow into preventative care in the way it should do, adding it is not also used effectively to keep people with chronic conditions out of hospital, not encouraging acute trusts to work with primary care to keep people fit and out of hospital. He expressed the need to use financial levers to greatly improve healthcare, with incentives for commissioners to engage in preventative healthcare.
At another fringe meeting it was suggested that a single, joined up social care system, integrating health, social care and benefit strands, needed to be created to provide a workable system for the future.
The news was provided by De Havilland, who provide the DDA with political news all year round.